Laterofixation of the vocal fold using an endo-extralaryngeal needle carrier for bilateral vocal fold paralysis

Objectives

Laterofixation of the vocal fold is a simple and reliable surgical intervention for laryngeal obstruction due to bilateral vocal fold fixation to obtain sufficient glottal space. Nevertheless, it has some technical disadvantages. This report summarizes the surgical outcomes in patients who underwent laterofixation of the vocal fold with or without the use of an endo-extralaryngeal needle carrier (EENC).

Methods

A prospective study of 11 consecutive patients with bilateral vocal fold paralysis. All of the patients underwent unilateral vocal fold laterofixation. Six patients were assigned to the non-EENC group and five to the EENC group. The surgical outcomes were evaluated, including the operating time and respiratory and phonatory functions.

Results

The operating time was 44% shorter in the EENC group and less skin incisions were required. Postoperatively, the dyspnea was eliminated in all of the patients in both groups, and the six patients who required a tracheotomy were successfully decannulated. Spirometry confirmed the improvements in %FEV₁ and %PEF in the two groups. Postoperative voice function was socially acceptable in all patients, and it tended to be better in the non-EENC group. In the EENC group, one patient developed a minor submucosal hematoma and another patient had a recurrence of dyspnea 2 months postoperatively, probably due to thread disruption.

Conclusion

The present study confirms that laterofixation of the vocal fold with or without EENC relieves laryngeal obstruction. Surgery with the EENC is simpler and quicker than the conventional procedure. However, the surgery with the EENC has some disadvantages, including likely problems with the thread and downward traction on the vocal fold. Surgeons should be aware of these possible shortcomings.